Korean J Gastrointest Endosc > Volume 21(4); 2000 > Article

Korean Journal of Gastrointestinal Endoscopy 2000;21(4): 763-768.

내과 중환자실에서 위장관 출혈의 원인 ( Etiology of Gastrointestinal Bleeding in Intensive Care Unit )

이경수(Gyung Soo Lee),김영호(Young Ho Kim),박동일(Dong Il Park),류민규(Min Gyu Ryu),문원(Won Moon),강태욱(Tae Wook Kang),이풍렬(Pung Ryul Lee),김재준(Jae Jun Kim),백승운(Seung Woon Baek),이종철(Jong Chul Lee),최규완(Gyu Wan Choi)

Abstract

Backgound/Aims: Gastrointestinal (GI) bleeding remains a common medical problem, with morbidity and mortality rates of GI bleeding in intensive care unit (ICU) believed to have remained unchanged. There has been no report about the etiology and clinical manifestation of GI bleeding in ICU in Korea. Therefore, we performed this study to determine the frequency, etiology, risk factors, and outcome of clinically significant GI bleeding that occurred after admission to ICU.
Methods:
We reviewed medical records of 1829 patients admitted to medical ICU in Samsung Medical Center from October 1994 to May 1999, Cases were enrolled the patients who developed GI bleeding more than 24 hours after admission to the medical ICU. The cases were compared with control populations: a set of ICU patients without GI bleeding matched with cases for age, gender, and length of ICU stay to evaluate the risk factors of GI bleeding.
Results:
Clinically significant GI bleeding, confirmed by endoscopy, occurred in 71 patients of 1,829 patients (3.9%) after a mean ICU stay of 14±2.6 days. Gastric ulcer bleeding was the most common source of GI bleeding, accounting for 29.6% of cases overall. There were no statistical differences in underlying disease, mechanical ventilator use, heparin or steroid use, prothrombin time, prophylactic drug use such as H₂. blocker and antacid use between cases and controls. However, thrombocytopenia (<50,000/mm³) was more common in cases who had GI bleeding than controls (P<0.05).
Conclusions:
Gastric ulcer was the most common cause of GI bleeding in ICU and careful attention was necessary to patients with thrombocytopenia (<50,000/mm³) in ICU.

Key Words: Gastrointestinal bleeding , Intensive care unit , Thrombocytopenia